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Antimikrobielle Therapie bei intensivpflichtigen Patienten mit akuter Exazerbation einer COPD

Antimicrobial treatment of patients with severe acute exacerbation of COPD

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Zusammenfassung

Die chronisch-obstruktive Lungenerkrankung (COPD) gehört zu den führenden Todesursachen weltweit. Bei intensivpflichtigen Patienten mit akuter Exazerbation können dabei in etwa 50% der Fälle potenzielle bakterielle Erreger gefunden werden. Am häufigsten sind Haemophilus influenzae und Streptococcus pneumoniae, aber auch Enterobakterien und Pseudomonas aeruginosa. Ebenso können Viren in einem hohen Anteil der Patienten nachgewiesen werden. Die Indikation zur antimikrobiellen Therapie der akut exazerbierten COPD wird weiterhin kontrovers diskutiert, jedoch von aktuellen Leitlinien für alle intensivpflichtigen Patienten empfohlen. Geeignete Substanzen zur empirischen initialen antimikrobiellen Therapie sind Penicilline mit β-Laktamaseinhibitor, Cephalosporine der zweiten und dritten Generation, Carbapeneme und Fluorchinolone. Die antimikrobielle Therapie sollte nach den kulturellen Ergebnissen von Sputum oder tracheobronchialen Sekreten angepasst werden.

Abstracts

Chronic obstructive lung disease (COPD) is a leading cause of death worldwide. In patients with acute exacerbations admitted to an intensive care unit (ICU), potentially pathogenic microorganisms can be found in approximately 50%, with Haemophilus influenzae and Streptococcus pneumoniae as the leading strains, followed by enterobacteria and Pseudomonas aeruginosa. Viruses can also be detected in a large proportion of patients. The indication for antimicrobial treatment of acutely exacerbated COPD is still controversial but recommended by guidelines for all patients admitted to an ICU. Appropriate agents for an empiric initial treatment are penicillins + betalactamase inhibitor, 2nd and 3rd generation cephalosporins, carbapenems, and quinolones. Antimicrobial treatment should be adjusted according to the results of microbial investigation of sputum or endotracheal aspirate.

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  1. Thoraxzentrum Ruhrgebiet, Kliniken für Pneumologie und Infektiologie, EVK Herne und Augusta-Krankenanstalt Bochum, Bergstr. 26, 44791, Bochum, Deutschland

    B. Klapdor &  S. Ewig

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Correspondence to S. Ewig.

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Klapdor, B., Ewig, S. Antimikrobielle Therapie bei intensivpflichtigen Patienten mit akuter Exazerbation einer COPD. Med Klin Intensivmed Notfmed 107, 179–184 (2012). https://doi.org/10.1007/s00063-011-0066-x

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  • DOI: https://doi.org/10.1007/s00063-011-0066-x

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